Equal long-term care for equal needs with universal and comprehensive coverage? An assessment using Dutch...

Area of Science:

• Health Economics
• Social Policy
• Gerontology

Background:

• The Netherlands provides universal public long-term care (LTC) coverage.
• Equity in LTC access for elderly individuals with similar needs, regardless of income, is a key policy concern.

Purpose of the Study:

• To investigate inequities in LTC use among the Dutch elderly based on income.
• To determine if universal public LTC coverage ensures equitable access for similar care needs.

Main Methods:

• Utilized administrative register data for 616,934 individuals aged 60+ eligible for public LTC.
• Employed an administrative measure of LTC needs from the Dutch LTC assessment agency.

Main Results:

• Observed a significant pro-poor concentration in LTC use, partially explained by greater needs in lower-income groups.
• Higher-income individuals eligible for institutional care were more likely to use less expensive home care.
• Differences in preferences, copayments, and feasibility of home-based care may explain income-related disparities.

Conclusions:

• Dutch LTC insurance may exceed its accessibility goals for poorer elderly.
• The findings highlight complex interactions between income, care needs, preferences, and care utilization in universal LTC systems.
• Further investigation into the origins of these differences and normative stances is necessary to fully interpret the results.